Author: The following review is by Tara Parker-Pope. Tara Parker-Pope is the creator and writer of “Well,” a daily health blog and weekly column for The New York Times. Well features and stories focus primarily on the small everyday decisions we make about food, family and fun that ultimately influence our long-term health and happiness. Prior to joining the Times in August 2007, Tara was the long-time health columnist for The Wall Street Journal, and also worked as a correspondent in the paper’s London bureau.

Is mental decline an inevitable part of getting old?

For years the conventional wisdom has been that people are at the mercy of genetics and fate when it comes to their aging brains. But a new understanding of how the brain works has turned that theory on its head.

Now scientists know that the brain, like other organs, is affected–dramatically–by how it is treated. Just as people can do their part with diet and exercise to prevent physical ailments such as heart disease and diabetes, they can take steps to protect their brains and stave of mental decline.

The theory is that by being proactive now, anyone can create a “reserve” of brain cells and pathways to fall back on as the brain ages.

“As you build your brain reserve throughout your life you’re going to be protected from decline in late life,” says Howard Fillit, executive director for the Institute for the Study of Aging in New York City. “There has be a real paradigm shift in the way we think.”

Most experience some mild memory loss or other cognitive changes as they age. They may forget words or be slower to learn new things, but the problems generally don’t result in any marked impairment. However, about 25 percent of people older than 75 and 40 percent of people older than 80 have more serious cognitive decline.

A growing body of research shows that many cognitive problems can be delayed or prevented–and some even reversed–with a little physical and mental effort by the patient.

Doctors now know that physical exercise improves brain function by improving blood flow to the brain. But it also is believed to trigger the production of neurons–the nerve cells that enable a person to think. Exercise also stimulates the production of a chemical–brain-derived neurotrophic factor–that helps repair cells and prevent further damage.

The brain isn’t hard-wired at birth. And because it’s an ever-changing organ, an individual’s activities can influence how it develops. Studies of concert violinists, for example, show that the part of the brain that controls the functions of the left hand is far more developed than in the average person.

Doctors say new mental challenges–learning a second language, taking piano lessons, attending lectures, tackling a crossword puzzle, reading a difficult book–help to map out new pathways in the brain. The effect is likened to a driver who knows only one route to work. If that road is damaged or filled with traffic, he’s stuck. But if the driver learns several routes, he can still get where he wants to go even if certain paths become blocked.

“Every time you learn something new it builds new connections to the brain cells,” says Margery Silver, assistant professor of psychology at Harvard Medical School and associate director of the New England Centenarian Study. “That way, if you do have a few changes–a few plaques and tangles associated with Alzheimer’s–and a few brain cells become damaged, you still have a reserve because of all these additional connections you built up.”

Managing other diseases and health problems also can play a significant role. Depression is a major cause of dementia in elderly people, but once treated, the dementia symptoms can be reversed. Untreated hypertension and vascular disease can trigger vascular dementia, the second most common form of age-related dementia.

High cholesterol also is a risk factor for Alzheimer’s. Recent studies show that cholesterol-lowering statin drugs may help protect against the disease. It’s not yet clear whether the benefit comes from the lowered cholesterol or if the drug have an effect that staves off the disease.

“What we need to be saying to patients is that if you have hypertension you should take your medicine ever day, not just to prevent a heart attack 10 years from now but to prevent your mind getting demented in old age,” Fillit says.

Someone who appears to be suffering memory loss or other problems should see a doctor. “It’s very important to get a dementia evaluation,” Silver says. “Many things are curable, or at least the progress can be slowed down.”

A study in the New England Journal of Medicine found that nonsteroidal, anti-inflammatory drugs such as ibuprofen may greatly reduce Alzheimer’s risk. Some research also has shown that daily low-dose aspirin therapy, often recommended for people at risk for heart attack and stroke, may also help prevent cognitive decline, but the data are conflicting.

Antioxidants such as vitamin E also may help stave of mental decline and work, in essence, “like keeping rust from forming on a pipe,” says Guy M. McKhann, professor of neurology and neuroscience at John Hopkins School of Medicine, Baltimore.

But the most important factor in preventing mental decline is to stay physically, mentally, and socially active, experts say.

“You don’t want to just retire and sit around and do nothing and say ‘Isn’t this great, I don’t have to think anymore,’ ” says Marilyn Albert, Harvard professor of psychiatry and neurology. “That’s actually going to hurt your brain.”

Printed in the Kansas City Star on Monday, December 31, 2001. Read more from www.taraparkerpope